November 18, 2009

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The Senate bill pushes back implementation of major parts of the reform to 2014 -- a change from 2013 under the Finance Committee bill.

This is bad news for lawmakers who will need to explain to constituents why the elements that have attracted the most attention -- the public plan, the Medicaid expansion and the insurance exchanges -- won't be available for four years.

Some reforms would kick in earlier, Senate aides explained, but the big pieces would still be a ways off.

Aware of the political pitfalls, the Senate Democratic leadership compiled a list of early "deliverables."

Check it out after the jump.

The Patient Protection and Affordable Care Act

Immediate Benefits

The Patient Protection and Affordable Care Act includes health insurance market reforms that will bring immediate benefits to millions of Americans, including those who currently have coverage. The following benefits will be available in the first year after enactment of the Patient Protection and Affordable Care Act.

Access to Affordable Coverage for the Uninsured with Pre-existing Conditions
- The Patient Protection and Affordable Care Act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions.
- Coverage under this program will continue until new Exchanges are operational.

Re-insurance for Retiree Health Benefit Plans
- The Patient Protection and Affordable Care Act will create immediate access to re-insurance for employer health plans providing coverage for early retirees.
- This re-insurance will help protect coverage while reducing premiums for employers and retirees.

Closing the Coverage Gap in the Medicare (Part D) Drug Benefit
- The Patient Protection and Affordable Care Act will reduce the size of the “donut hole” by raising the ceiling on the initial coverage period by $500 in 2010.
- The Patient Protection and Affordable Care Act will also guarantee 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap.

Small Business Tax Credits
- The Patient Protection and Affordable Care Act will offer tax credits to small businesses to make employee coverage more affordable.
- Tax credits of up to 50 percent of premiums will be available to firms that choose to offer coverage.

Extension of Dependent Coverage for Young Adults
- The Patient Protection and Affordable Care Act will require insurers to permit children to stay on family policies until age 26.

Free Prevention Benefits
- The Patient Protection and Affordable Care Act will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage.

No Arbitrary Limits on Coverage
- The Patient Protection and Affordable Care Act will prohibit insurers from imposing lifetime limits on benefits and will restrict the use of annual limits.

Protection from Rescissions of Existing Coverage
- The Patient Protection and Affordable Care Act will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact.

Prohibits Discrimination Based on Salary
- The Patient Protection and Affordable Care Act will prohibit group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees.

Ensuring Value for Premium Payments
- The Patient Protection and Affordable Care Act will establish standards for insurance overhead to ensure that premiums are spent on health benefits.
- The Patient Protection and Affordable Care Act will also require public disclosure of overhead and benefit spending and require premium rebates for insurers that exceed established standards for overhead expenses.

Public Access to Comparable Information on Insurance Options
- The Patient Protection and Affordable Care Act will enable creation of a new website to provide information on and facilitate informed consumer choice of insurance options.

Health Insurance Consumer Information
- The Patient Protection and Affordable Care Act will provide assistance to States in establishing offices of health insurance consumer assistance or health insurance ombudsman programs to assist individuals with the filing of complaints and appeals, enrollment in a health plan, and, eventually, to assist consumers with resolving problems with tax credit eligibility.

Clear Summaries, Without the Fine Print
- The Patient Protection and Affordable Care Act will require insurance companies to outline coverage options using a simple and standard format that enables consumers to make an apples-to-apples comparison when they are choosing their health insurance plan.

Appeals Process
- Under The Patient Protection and Affordable Care Act, all health plans will implement an effective appeals process for appeals of coverage determinations and claims.

Administrative Simplification
- Under the Patient Protection and Affordable Care Act, all health plans will adopt uniform descriptions of plan benefits and appeals procedures and will use uniform forms and claims processing processes to reduce costs.

Posted by Carrie Budoff Brown 09:10 PM

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The only suitable major reform Congress should take is deconstructing the mess they've created. Stop spending money. Audit the Federal Reserve and take steps to eliminate the central bank. Withdraw US troops immediately from all parts of the globe. The money saves could pay for all sorts of much needed infrastructure and services. Things have gotten so out of whack with these power-drunken fools we're currently on the verge of bankruptcy.

By 2014 most everyone in Congress will be gone and we will be left with the bill.....Congress doesn't make money they SPEND our money.....Do you like someone else spending on your credit card over the limit and then disappearing?

This just gives the GOP four years to stop funding for the bad parts of the bill when they get back into power. Stupid Dems thought they had a mandate to spend money like it's somebody elses. Looks like they are about to find out that other person is ticked off and is going to put them back into the minority.

While this is not the final bill the President would sign, remarkably it is a reasonable and acceptable bill. Unfortunately there is still set of major problems the bill has to overcome, politics, selfishness, ego and immaturity. Let's hope we all get lucky and have the Senate pass this bill. If it does get signed I think it will be purely by luck although Reid's engineering of the bill has pleasantly surprised me, I say congratulations to him for getting it this far, especially having the guts to include the public option.

The key reason this bill (and the house bill) reduce the deficit over a 10 year period is found in section 9015. ADDITIONAL HOSPITAL INSURANCE TAX ON HIGH-INCOME TAXPAYERS.
This section imposes a 0.5% tax on couples making more than $250k, but fails to index that threshold to inflation. That tax increase takes affect in 2012, while the benefits don't take affect until 2014. Failing to index that threshold to inflation results in a gradual and continuous tax increase over time - the threshold stays the same, but the percentage of the population subject to that threshold grows. This means a couple that made $225,000 in 2008 will be subject to the $250,000 threshold in 2012. Couples who made $192,000 in 2008 will pay the tax in 2014.
This assumes normal, average wage growth.

the insurers agreed to give up preex last March in exchange for the universal mandate to get more customers. The appeals process is already the LAW in every state AND at the Federal level under ERISA
The 500 donut lift is nothing compared to the 500 Billion they plan to gut from medicare.
The lack of interstate insurance competition gives we consumers no more choices and the mandate forces us to give business to insurers or be fined/jailed, during the worst recession in my lifetime.
the POTUS cut a deal with Pharma and Billy TGauzin to stop Americans from reimporting RXs from Canada, another loss for the Consumer
this is a giant gift to insurance companies
we will be trapped and forced to buy something when we cannot afford it with NO SUBSIDIES until 2013????!!!
an utter disaster

Hey - a litle reality check. Most Americans are either covered by Medicare, Medicaid or by a self-insured plan governed by ERISA. These insurance reforms are aimed at a comparatively small slice of the market.
Also - how do we afford yet another middle class entitlement when we can't afford the ones that we have already committed to?

Tax Now ..benefit(?) later? (Well An't that grand!)
WHERE IN THE CONSTITUTION DOES IT REQUIRE I HAVE TO BUY INSURNACE OR BE PENALIZED? What next I have to buy a GM car?
-How MUCH Additional Cost handed to States who are already struggling?
-How many are not covered?
-At what cost?
-Medicare for Seniors slashed by what?
-How big is the bureauacracy to support this boondoggle?
-The Doc/Medicare cost fix not included in cost?
DOES CONGRESS USE THE SAME PLAN?

I don't understand the mentality of those who gloat over the prospect of a brutally dishonest piece of legislation being foisted on the electorate. The bill is nothing but a shell game that hides $280 billion of payments to doctors in supplemental bills, $450 billion in Medi-Care cuts to seniors and $350 billion in hidden taxes which are then presented as 10-years worth of savings while only implementing the costs of 6 years worth of medical services. This bill is a monstrosity that Reid and Pelosi will paint as the salvation of America. DO NOT BE FOOLED! The bill is a mish-mash of disingenuous double-talk, the back room deals of lobbyists and special interest while fraught with union pay-offs and the type of social engineering that only the progressives and their Marxist base could cobble together and celebrate as victory for America. The bureaucracies this bill creates will encumber entire sectors of the American Economy and leave others virtually non-existent. We will look to this bill in the future as the single most destructive piece of legislation that this country has ever produced. And if you want the bureaucrats to be in TOTAL control of your life, then just sit back, put your head back in the sand and just forget about that uncomfortable sensation emanating from your backside, because to use the vernacular, the Democrats just tore you a new one.
The fact remains that this bill will be held up for decades to come as the epitome

So let me get this straight - For the next 4 years this plan covers Zero more people out of the 46million. After that about 18 million will still be uncovered. In the mean time since the pre-existing conditions rule is applied, everyone that has insuance will see their insurance increase which will mean more people dropping their insurance. Now I get it, its a typical libatard plan.

"So let me get this straight - For the next 4 years this plan covers Zero more people out of the 46million. "

But the article says:

The Patient Protection and Affordable Care Act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions."

Also relevent:
"...will create immediate access to re-insurance for employer health plans providing coverage for early retirees. This re-insurance will help protect coverage while reducing premiums for employers and retirees."

Increase taxes and cut Medicaid benefits for 4 years before the socalled benefits of the plan go into effect. That sounds like a scheme that Bernie Madoff would come up with. The ultimate ponzi scheme. Steal peoples money today with a promise of a benefit 4 years down the road.

A lot of us are Christians and insuring 96% of all Americans will SAVE AMERICAN LIVES.

There opposition to this is entirely ideological "big government bad". The partisan opponents of this bill have no plan to save American lives. The CBO says that Tort reform will only save 0.5% (whereas premiums are increasing at 7% a year). They say they want insurance to be available across state lines, but they refuse to say what happens to the state based consumer protections.

At its start, in 1966, Medicare cost $3 billion. The House Ways and Means Committee estimated that Medicare would cost only about $ 12 billion by 1990 (a figure that included an allowance for inflation). This was a supposedly "conservative" estimate. But in 1990 Medicare actually cost $107 billion." This time they are starting out by lying to us because their budget estimates for the next ten years are for 6 years of coverage and 10 years of tax hikes and medicare cuts. Lying thieves.
This bill is a government takever and loss of our freedoms. Contact your state's senators and these as many times as possible before the vote.
Sen. Evan Bayh (D-IN) 202-224-5623
Sen. Kent Conrad (D-ND) 202-224-2043
Sen. Blanche Lincoln (D-AR) 202-224-4843
Sen. Joe Lieberman (I-CT) 202-224-4041
Sen. Byron Dorgan (D-ND) 202-224-2551
Sen. Claire McCaskill (D-MO) 202-224-6154
Sen. Mary Landrieu (D-LA) 202-224-5824
Sen. Bill Nelson (D-FL) 202-224-5274
Sen. Ben Nelson (D-NE) 202-224-6551
Sen. Michael Bennet (D-CO) 202-224-5852
Sen. Jon Tester (D-MT) 202-224-2644

John's conscience is a clown. We were all thinking it. I am a Chistian, and a Physician, and a Republican. I donate time and money to provide care for those who can't afford it. So don't lecture me. This bill will not save lives (especially when abortion gets worked back in, and it will.) And if the bill is about insuring the uninsured we could do that for about 20% of this amount of proposed spending. The majority of uninsured is already elligible for medicaid and no one is denied treatment who goes into the hospital. You don't have to screw up 95% of people's health coverage to insure another 3%. Besides this bill is an enormous job killer. If you believe in Christian principles why don't you go help people around you instead of having the government force people to pay everyone else's way. More beurocracy is not the answer (as evidenced by the current unemployment rates, even after we spent $1,000,000,000,000.00 to "keep unemployment under 8%.)

Bringreaganback says: "John's conscience is a clown. We were all thinking it. I am a Chistian, and a Physician, and a Republican. "

I am sure you are all those things, except being a Christian.

45,000 Americans die each year as a result of not having health insurance. You are fighting to keep it that way.

Tell your story to Robin Beaton, who had health insurance, and was cancelled AFTER she was diagnosed with agressive breast cancer. The insurance company's excuse? She didn't report acne on her application. By the time her Congressman intervened, and convinced the insurance company to reverse their decision, the mass had grown from 2 cm to 7cm.

What if that was your wife or daughter who had her surgery CANCELLED when her insurance company reneged. What if it were a member of your family who had to live with the knowlege that this cancer mass was growing in her body and could spread the rest of her body at any time.

Here is what the non-partisan CBO told Orrin Hatch about how much savings we can achieve through tort reform of the kind favored by Republicans:

"CBO now estimates, on the basis of an analysis incorporating the results of recent
research, that if a package of proposals such as those described above was enacted, it
would reduce total national health care spending by about 0.5 percent (about $11 billion
in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect
reduction of 0.3 percent from slightly less utilization of health care services."

Hey, John's Conscience: In light of the fact that you think that 45,000 deaths per year attributed to lack of insurance justifies an unConstitutional individual Federal Mandate to purchase a health insurance policy, I would submit to you that more than SEVENTY FIVE THOUSAND Americans die EVERY year as a result of alcohol. Bring back Prohibition. Additionally, more than THREE HUNDRED SIXTY FIVE THOUSAND Americans die every year due to obesity, including more than ONE HUNDRED THOUSAND from obesity related cancer. We apparently need a Federal Law banning Big Mac's, too. You're an idiot, John's Conscience. AND a fraud. Kindly keep your "conscience" out of MY POCKET, thankyouverymuch.

The 5 billion for the currently uninsured will bridge the gap for the 4 year delay in the public option.
Its basically a stop gap public option.
It was John McCain's idea in the campaign and Obama said he thought is was a good idea. This was people who have no insurance will get it while they get the public option rolling.

Ferret: If you think about it, this bill WILL cut a large chunk out of the 190,000 Americans who are killed each year because doctors or hospitals gave them the wrong care.
If they aren't giving ANY care, they can't give the WRONG care, di ba?

What a joke. So, for a couple of minor new benefits, we all get to pay higher taxes for three years. These taxes are applied against the actual cost of the program, as though it was fully implemented, thereby driving down the first 10-year cost. Can anyone say, "liar."

I for one am tired of the Dems bad mouthing the Republicans and the GOP doing the same to the Dems. Its so ugly and produces nothing but anger and bad legislation.
We have a real problem with health care. We all agree that fixes are in order. Why wont the Dems understand that another entitlement program scares the ---- out of everyone. There will be no health care for any of us if we go broke.
Republicans have great ideas that have not been given a chance. The Dems say the GOP has no ideas but thats a bold face lie.
A good plan would be one that both parties can find favor with. It doesnt need to be this difficult.
Our country despararetely needs real leadership.

Johnsconscience- You are full of nonsense. Fixing preexisting conditions and recissions are good idea, but that hardly creates a reason for the massive government expansion you people want, You dont want reform, you want big daaddy to take over and take care of you. In line wtht the above poster -we lose 40,000 people annually to car accidents, I assume you want to ban them and put everyone on public transportation?

Public option plans will be banned from including abortion coverage. Most employer provided private plans today do cover abortion. So if you want less abortions you must support the most robust, largest public option, If you are against the public option you are taking the PRO-abortion position, encouraging more abortions.

All these monkeys in DC need to go. Not one of them cares about the people they are supposed to represent. Oh, yea, the LAME-STREAM media can go too. Fox for the most part is the only one trying to do both sides. The others are so one sided it sicking! Maybe numb-nuts Grayson had it right, let me die quickly to get away from this mess.

These scum sucking politicians don't care what this cost the taxpayer. The ones pushing it are delusional, the only people wanting this are the same ones that think the government owes them a living.....society's leeches...."I'm here to get some obama money" "we love obama, we love obama"..."he getting it from his stash"!

I think JohnConscience has a great idea!
Let's let the Christians pay for healthcare those that cannot afford it through their fund raising ministries. No taxes, it will not hurt the economy and we'll gladly give them all of the credit.